Acute treatments are medications taken at the first sign of migraine headache. These treatments don’t prevent migraine, but they offer pain relief during an episode. Most of these drugs must be taken at the first sign of migraine for best results.

Topiramate for prevention of chronic migraines

Topiramate (Topamax) is a drug originally approved for the treatment of seizures in people with epilepsy. It’s now also approved by the U.S. Food and Drug Administration (FDA) to prevent chronic migraine. The drug can prevent headaches, but side effects may keep some people from taking it on a long-term basis.

Beta-blockers for the prevention of migraine

Beta-blockers are considered first-line therapy for the prevention of chronic migraine. Although doctors don’t know why beta-blockers can help, many people find taking them reduces the number of headaches they get.

Although not specifically approved for this use, beta-blockers, such as propranolol, are relatively inexpensive.

They have fewer side effects than some other drugs. They’re ordinarily used to treat anxiety disorders and help control high blood pressure. Other drugs in this class include:

Depression and anxiety disorders are common among people who have migraine. Research suggests that worsening depression is frequently linked to a greater risk of episodic migraines becoming chronic migraine. It’s important for doctors to evaluate and treat people with migraine for the presence of depression or anxiety.

Certain antidepressant medications have been used successfully to treat depression and reduce migraine recurrence. Suitable drugs include older tricyclic antidepressants, such as amitriptyline or imipramine. Botox may also act as an antidepressant, according to emerging research.

Preliminary clinical trials indicate a device pioneered for use in spinal cord injury may prove useful for the prevention of chronic migraine.

Known as an occipital nerve stimulator, the device delivers a weak electrical current directly to the brain through implanted electrodes. Broadly called peripheral neuromodulation, the technique of “shocking” the occipital nerve or other portions of the brain is an extreme, yet promising, new therapy.

Although not yet approved for this use by the FDA, the technology is under investigation for the off-label treatment of chronic migraine.

A new class of medication called CGRP antagonists are under investigation for the prevention of migraine, too. The FDA recently approved enerumab-aooe (Aimovig) for this reason. Several other similar medications are in trials.

While they’re typically tolerated well, the high cost and need for monthly injections means it may be a little while before these medications are widely used.